Treatment procedure planning system and method

ABSTRACT

A system and method for planning surgical procedure including importing CT image data of a patient; generating a 3D reconstruction from the CT image data; presenting a slice of the 3D reconstruction; selecting a target anatomical feature from the slice of the 3D reconstruction; setting a treatment zone including presenting at least one slice of the 3D reconstruction including the target anatomical feature, and presenting a treatment zone marker defining a location and a size of the treatment zone on the presented at least one slice of the 3D reconstruction; setting an access route to the treatment zone; and presenting a three-dimensional model including the treatment zone and the access route.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of, and priority to, U.S.Provisional Patent Application Nos. 62/035,851 and 62/035,863, both ofwhich were filed on Aug. 11, 2014. This application is related to U.S.patent application Ser. No. 14/821,912, filed on Aug. 10, 2015. Theentire contents of each of the above applications are herebyincorporated herein by reference.

BACKGROUND

1. Technical Field

The present disclosure relates to a system and method for planning atreatment procedure.

2. Discussion of Related Art

When planning a treatment procedure, clinicians often rely on patientdata including X-ray data, computed tomography (CT) scan data, magneticresonance imaging (MRI) data, or other imaging data that allows theclinician to view the internal anatomy of a patient. The clinicianutilizes the patient data to identify targets of interest and to developstrategies for accessing the targets of interest for the surgicalprocedure.

The use of CT images as a diagnostic tool has become routine and CTresults are frequently the primary source of information available to aclinician regarding the size and location of a lesion, tumor or othersimilar target of interest. This information is used by the clinicianfor planning an operative procedure such as a biopsy or an ablationprocedure, but is only available as “offline” information which musttypically be memorized to the best of the practitioner's ability priorto beginning a procedure. CT images are typically obtained by digitallyimaging a patient in slices in each of the axial, coronal and sagittaldirections. A clinician reviews the CT image data slice by slice fromeach direction when attempting to identify or locate a target. It isoften difficult, however, for the clinician to effectively plan asurgical ablation procedure based on the X-rays, CT images, or MRIs intheir raw form.

SUMMARY

Systems and methods for planning a treatment procedure are provided.

In an aspect of the present disclosure, a system for planning atreatment procedure is disclosed including a computing device having amemory and at least one processor and a program stored in the memorythat, when executed by the processor, presents a user interface thatguides a user through the planning of a treatment procedure. The userinterface includes a target selection view presenting a slice of a 3Dreconstruction generated from CT image data of a patient. The targetselection view is configured to select at least one target anatomicalfeature from the presented slice in response to a received user input.The user interface further includes a treatment zone setting viewpresenting at least one slice of the 3D reconstruction including thetarget anatomical feature. The treatment zone setting view furtherpresents a treatment zone marker defining a location and a size of atreatment zone. The treatment zone setting view is configured to adjustthe treatment zone marker in response to a received user input. The userinterface further includes an access route setting view configured toset an access route to the treatment zone in response to a received userinput and a review view configured to present a three-dimensional modelof the treatment zone and the access route.

In another aspect of the present disclosure, one or more of thetreatment zone setting view, access route setting view, and review vieware presented separately.

In a further aspect of the present disclosure, at least one dimension ofthe treatment zone marker is adjustable in response to a received userinput to adjust the size of the treatment zone.

In a further aspect of the present disclosure, the treatment zonesetting view presents each of an axial slice of the 3D reconstruction, acoronal slice of the 3D reconstruction and a sagittal slice of the 3Dreconstruction. In an aspect of the present disclosure, the adjustmentof the at least one dimension of the treatment zone marker in responseto the received user input in one of the axial, coronal, and sagittalslices adjusts at least one dimension of the treatment zone marker in atleast one other of the axial, coronal, and sagittal slices.

In yet another aspect of the present disclosure, the treatment zonesetting view further presents at least one treatment parameter value.The at least one treatment parameter value is adjustable in response toa received user input.

In a further aspect of the present disclosure, the at least onetreatment parameter value is selected from the group consisting of apower setting, a duration setting, an instrument type, and a size of thetreatment zone.

In another aspect of the present disclosure, adjusting the at least onetreatment parameter value automatically adjusts at least one othertreatment parameter value.

In an aspect of the present disclosure, the treatment zone is presentedin the three-dimensional model as a three-dimensional treatment volume.

In an aspect of the present disclosure, a non-transitorycomputer-readable storage medium is disclosed that is encoded with aprogram that, when executed by a processor, causes the processor toperform the steps of importing CT image data of a patient, generating a3D reconstruction from the CT image data, presenting a slice of the 3Dreconstruction, selecting a target anatomical feature from the slice ofthe 3D reconstruction in response to a received user input, setting atreatment zone in response to a received user input including presentingat least one slice of the 3D reconstruction including the targetanatomical feature and presenting a treatment zone marker defining alocation and a size of the treatment zone on the presented at least oneslice of the 3D reconstruction, setting an access route to the treatmentzone in response to a received user input, and presenting athree-dimensional model including the treatment zone and the accessroute.

In another aspect of the present disclosure, the setting of thetreatment zone includes adjusting at least one dimension of thetreatment zone marker to adjust the size of the treatment zone.

In yet another aspect of the present disclosure, the treatment zonemarker is presented in each of an axial slice of the 3D reconstruction,a coronal slice of the 3D reconstruction, and a sagittal slice of the 3Dreconstruction. In a further aspect of the present disclosure,adjustment of the at least one dimension of the treatment zone marker inone of the axial, coronal, and sagittal slices automatically adjusts atleast one dimension of the treatment zone marker in at least one otherof the axial, coronal, and sagittal slices.

In another aspect of the present disclosure, setting the treatment zonefurther includes presenting at least one treatment parameter value, andadjusting the at least one treatment parameter value.

In a further aspect of the present disclosure, the at least onetreatment parameter value is selected from the group consisting of apower setting, a duration setting, and instrument type, and a size ofthe treatment zone.

In yet a further aspect of the present disclosure, adjusting the atleast one treatment parameter value automatically adjusts at least oneother treatment parameter value of the treatment zone.

In another aspect of the present disclosure, the treatment zone ispresented in the three-dimensional model as a three-dimensionaltreatment volume.

In an aspect of the present disclosure, a system for planning atreatment procedure is disclosed. The system includes a computing devicehaving a memory and at least one processor, and a program stored in thememory that, when executed by the processor, presents a user interfacethat guides a user through the planning of the treatment procedure. Theuser interface includes a treatment zone setting view presenting atleast one slice of a 3D reconstruction generated from CT image dataincluding a target. The treatment zone setting view further presents atreatment zone marker defining a location and a size of a treatment zoneand is configured to adjust the treatment zone marker in response to areceived user input. The user interface further includes a volumetricview presenting a 3D volume derived from the 3D reconstruction and a 3Drepresentation of the treatment zone marker relative to structuresdepicted in the 3D volume.

In another aspect of the present disclosure, the representation of thetreatment zone marker in the volumetric view is a wireframe.

In yet another aspect of the present disclosure, the 3D volume iscentered on one of the target, a target marker, the treatment zonemarker, or a distal portion of an instrument.

In an aspect of the present disclosure, the 3D volume is rotatable inresponse to a received user input.

In a further aspect of the present disclosure, the 3D volume has a shapeselected from the group consisting of, a cubic shape, a rectangularshape, a pyramid shape, and a spherical shape.

In another aspect of the present disclosure, the at least one slice ofthe treatment zone setting view includes a representation of aninstrument. In a further aspect of the present disclosure, anorientation and a position of the representation of the instrument isadjustable in response to a received user input to adjust an orientationand position of the treatment zone marker in the treatment zone settingview.

In yet a further aspect of the present disclosure, the volumetric viewpresents a 3D representation of the instrument. In an aspect of thepresent disclosure, adjustment of the orientation and position of therepresentation of the instrument in response to the received user inputin the treatment zone setting view also adjusts a correspondingorientation and position of the 3D representation of the instrument andthe orientation and position of the 3D treatment zone marker in thevolumetric view.

In another aspect of the present disclosure, the representation of theinstrument in the at least one slice of the treatment zone setting viewincludes a depth marker slidably disposed thereon, the depth markerslidable to set a depth of insertion of the instrument in response to areceived user input.

In an aspect of the present disclosure, a non-transitorycomputer-readable storage medium is disclosed that is encoded with aprogram that, when executed by a processor, causes the processor toperform the steps of presenting at least one slice of a 3Dreconstruction generated from CT image data including a target,presenting a treatment zone marker defining a location and a size of atreatment zone on the presented at least one slice of the 3Dreconstruction, presenting a 3D volume derived from the 3Dreconstruction, and presenting a 3D representation of the treatment zonemarker relative to structures depicted in the 3D volume.

In another aspect of the present disclosure, the 3D representation ofthe treatment zone marker is a wireframe.

In yet another aspect of the present disclosure, the 3D volume iscentered on one of the target, a target marker, the treatment zonemarker, or a distal portion of an instrument.

In an aspect of the present disclosure, the computer program furthercauses the processor to rotate the 3D volume in response to a receiveduser input.

In a further aspect of the present disclosure, the 3D volume has a shapeselected from the group consisting of, a cubic shape, a rectangularshape, a pyramid shape, and a spherical shape.

In another aspect of the present disclosure, the computer program causesthe processor to present a representation of an instrument in the atleast one slice of the 3D reconstruction, to adjust an orientation and aposition of the representation of the instrument in response to areceived user input, and to adjust an orientation and a position of thetreatment zone marker in the at least one slice of the 3D reconstructionin response to adjustment of the orientation and position of therepresentation of the instrument.

In a further aspect of the present disclosure, the computer programcauses the processor to present a 3D representation of the instrumentrelative to structures depicted in the 3D volume, and to adjust anorientation and a position of the 3D representation of the instrumentand the 3D representation of the treatment zone marker in response toadjustment of the orientation and position of the representation of theinstrument and the orientation and position of the treatment zone markerin the at least one slice of the 3D reconstruction.

Any of the above aspects and embodiments of the present disclosure maybe combined without departing from the scope of the present disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

Objects and features of the presently disclosed system and method willbecome apparent to those of ordinary skill in the art when descriptionsof various embodiments thereof are read with reference to theaccompanying drawings, of which:

FIG. 1 is a schematic diagram of a computing device for treatmentplanning in accordance with an illustrative embodiment of the presentdisclosure;

FIG. 2 is a flow chart illustrating a method of treatment planning inaccordance with an embodiment of the present disclosure;

FIG. 3A is an illustration of a user interface presenting a view for theselection of patient data in accordance with an embodiment of thepresent disclosure;

FIG. 3B is an illustration of the user interface of FIG. 3A presentingCT image data for a selected patient;

FIG. 4A is an illustration of a user interface presenting a viewincluding an axial view CT slice for selecting and adding a target inaccordance with an embodiment of the present disclosure;

FIG. 4B is an illustration of the user interface of FIG. 4A illustratingan area of interest including a target in the axial view CT;

FIG. 4C is an illustration of the user interface of FIG. 4B presenting acoronal view CT slice including an illustration of the area of interest;

FIG. 5A is an illustration of a user interface presenting a view forediting target details of an added target in accordance with anembodiment of the present disclosure;

FIG. 5B is an illustration of the user interface of FIG. 5A illustratinga target marker sized to the added target;

FIG. 6A is an illustration of a user interface presenting a view forediting treatment zone details in accordance with an embodiment of thepresent disclosure;

FIG. 6B is an illustration of the user interface of FIG. 6A illustratinga treatment zone marker sized relative to a target;

FIG. 6C is an illustration of a user interface presenting a view forediting treatment zone details in accordance with an embodiment of thepresent disclosure;

FIG. 7 is an illustration of a user interface presenting a view forsetting an entry route to the target in accordance with an embodiment ofthe present disclosure;

FIG. 8 is an illustration of a user interface presenting a view forreviewing a 3D model of the treatment plan in accordance with anembodiment of the present disclosure;

FIG. 9 is an illustration of the user interface of FIG. 8 illustrating arepresentation of a patient's skin rendered over the 3D model;

FIG. 10 is an illustration of a user interface presenting a viewillustrating a representation of a patient's lung rendered in a 3D modeland including a representation of an instrument positioned along anentry route in accordance with an embodiment of the present disclosure;

FIG. 11 is an illustration of a user interface presenting a viewillustrating a representation of a patient's skin rendered over a 3Dmodel and including a section of the skin peeled back or removed in anarea of interest in accordance with an embodiment of the presentdisclosure;

FIG. 12 is an illustration of a user interface presenting a viewincluding a toolbox for adjusting display parameters of a slice of a 3Dreconstruction presented in the view in accordance with an embodiment ofthe present disclosure; and

FIG. 13 is an illustration of a user interface presenting a view forcomparing a pre-operative treatment plan to post-operative CT image datain accordance with an embodiment of the present disclosure.

DETAILED DESCRIPTION

The present disclosure provides a system and method for surgicaltreatment planning. The system presents a clinician with a streamlinedmethod of treatment planning from the initial patient selection througha process of target identification and selection, target sizing,treatment zone sizing, entry point and route selection, and treatmentplan review. The system also presents a clinician with the capability tocompare and contrast pre-operative and post-operative CT image data toassess the outcome of a surgical treatment procedure that has beenperformed.

Although the present disclosure will be described in terms of specificillustrative embodiments, it will be readily apparent to those skilledin this art that various modifications, rearrangements and substitutionsmay be made without departing from the spirit of the present disclosure.The scope of the present disclosure is defined by the claims appendedhereto.

Referring now to FIG. 1, the present disclosure is generally directed toa treatment planning system 10, which includes a computing device 100such as, for example, a laptop, desktop, tablet, or other similardevice, having a display 102, memory 104, one or more processors 106and/or other components of the type typically found in a computingdevice. Display 102 may be touch sensitive and/or voice activated,enabling display 102 to serve as both an input and output device.Alternatively, a keyboard (not shown), mouse (not shown), or other datainput devices may be employed.

Memory 104 includes any non-transitory, computer-readable storage mediafor storing data and/or software that is executable by processor 106 andwhich controls the operation of the computing device 100. In anembodiment, the memory 104 may include one or more solid-state storagedevices such as flash memory chips. Alternatively or in addition to theone or more solid-state storage devices, memory 104 may include one ormore mass storage devices connected to the processor 106 through a massstorage controller (not shown) and a communications bus (not shown).Although the description of computer-readable media contained hereinrefers to a solid-state storage, it should be appreciated by thoseskilled in the art that computer-readable storage media can be anyavailable media that can be accessed by the processor 106. That is,computer readable storage media includes non-transitory, volatile andnon-volatile, removable and non-removable media implemented in anymethod or technology for storage of information such ascomputer-readable instructions, data structures, program modules orother data. For example, computer-readable storage media includes RAM,ROM, EPROM, EEPROM, flash memory or other solid state memory technology,CD-ROM, DVD, Blu-Ray or other optical storage, magnetic cassettes,magnetic tape, magnetic disk storage or other magnetic storage devices,or any other medium which can be used to store the desired informationand which can be accessed by the computing device 100.

Computing device 100 may also include a network module 108 connected toa distributed network or the internet via a wired or wireless connectionfor the transmission and reception of data to and from other sources.For example, computing device 100 may receive computed tomographic (CT)image data of a patient from a server, for example, a hospital server,internet server, or other similar servers, for use during surgicalablation planning. Patient CT image data may also be provided tocomputing device 100 via a removable memory 104.

A treatment planning module 200 includes a software program stored inmemory 104 and executed by processor 106 of the computing device 100. Aswill be described in more detail below, treatment planning module 200guides a clinician through a series of steps to identify a target, sizethe target, size a treatment zone, and determine an access route to thetarget for later use during a surgical procedure. Some examples ofsurgical procedures for which surgical treatment planning may beperformed include ablation procedures, biopsy procedures, video-assistedthoracic surgery (VATS), open chest surgery, laparoscopic surgery, orany other type of surgery that could benefit from visualization andplanning of the surgical procedure. Treatment planning module 200communicates with a user interface module 202 which generates a userinterface for presenting visual interactive features to a clinician, forexample, on the display 102 and for receiving clinician input, forexample, via a user input device. For example, user interface module 202may generate a graphical user interface (GUI) and output the GUI to thedisplay 102 for viewing by a clinician.

As used herein, the term “clinician” refers to any medical professional(i.e., doctor, surgeon, nurse, or the like) or other user of thetreatment planning system 10 involved in planning, performing,monitoring and/or supervising a medical procedure involving the use ofthe embodiments described herein.

As used herein, the term “view” refers to any screen, image, overlay,user interface, window, or combination thereof, which may be projectedon or output to the display 102 by user interface module 202.

FIG. 2 depicts an exemplary method of treatment planning using thetreatment planning module 200 and the user interface module 202. Uponstarting treatment planning module 200, the user interface module 202presents the clinician with a view 210. As shown in FIG. 3A, view 210includes a list of patient data sets 212 that are available fortreatment planning. Each patient data set includes a patient identifier,for example, the patient's name or a unique patient ID, a date of birth,and patient CT image data for use during treatment planning. View 210also includes a selectable source location menu 214 that allows theclinician to select a source from which patient data sets 212 arereceived for use in treatment planning. In step S402 the clinicianselects from a number of storage or memory devices including, forexample, CD, DVD, Blue-ray, other optical media, universal serial bus(USB) memory devices, external or internal hard drives, solid statestorage devices, or any other type of memory or storage 104 connected toor in data communication with computing device 100, as described above.The view 210 may also provide access to patient data sets 212 stored ina remote location such as, for example, a server on a network or theinternet. Source location menu 214 may allow the clinician to select asingle source of patient data or may allow the clinician to selectmultiple sources of patient data at the same time. Source location menu214 may also include an option to list patient data sets 212 from allsources, as shown in FIG. 3A. Having selected a data source, in stepS404 the clinician selects the desired patient data set 212corresponding to a patient requiring a new treatment plan or a patientwhose treatment plan the clinician desires to review. The clinician maysearch through the list of patients data sets 212 or may input a searchterm in a search box 216 to narrow down the list of patients data sets212 to those meeting a selected criteria such as, for example, apatient's first or last name, ID number, date of birth, last accessed,or other similar criteria.

As shown in FIG. 3B, following selection of a patient data set 212, theuser interface element expands to present a menu 218 to the clinicianwhich includes a list of available CT image data 220 for the selectedpatient data set 212. Each available CT image data 220 is rated on acompatibility scale, for example, from one to five stars, to provide theclinician with an indication of whether a particular CT image data 220is compatible with the treatment planning system 10. Indicators ofcompatibility of CT image data may include, for example, the thicknessparameter of the CT scan, the interval parameter of the CT scan, imagegaps, resolution of the CT scan, field of view (FOV), the number ofimages, or other similar parameters of the CT scan. Additionally, thedate the CT image data 220 was captured and the date a treatment plan222 was generated from the CT image data may also be displayed.

In step S406, the clinician selects a desired CT image data 220 from thelist and in step S408 the treatment planning module 200 determineswhether there are any treatment plans 222 already present for theselected CT image data 220. If a previously created treatment plan 222is present for the selected CT image data 220, user interface module 202presents the clinician with a list of available treatment plans 222 forreview. In step S410, the clinician chooses to review a previouslygenerated treatment plan 222 by selecting an open plan option 226 or tocreate a new treatment plan by selecting a create new plan option 224from the menu.

View 210 also includes a capture screen option 228 that is selectable bythe clinician to capture an image of the current screen shown on thedisplay 102, for example, view 210, and save the captured image tomemory. The capture screen option 228 may also be configured to removepatient specific data from the captured image to protect patientprivacy. The removal of patient specific data may be an optionselectable by the clinician and may be set to “on” by default. Any ofthe views described herein may include a capture screen option 228 asdescribed above.

In step S412, when there are no treatment plans 222 already present orwhen the clinician has selected the create new plan option 224, thetreatment planning module 200 determines if a 3D reconstruction of the2D CT images (3D reconstruction) has been generated from selected CTimage data 220. If a 3D reconstruction has not been previouslygenerated, the CT image data 220 is imported into the treatment planningmodule 200 for processing in step S414, preferably in a DICOM format. Ingeneral, the computing device 100 processes the CT image data 220 andassembles the CT image data 220 into a 3D reconstruction by arrangingthe CT images in the order that they were taken and spacing the CTimages apart according a distance between slices set on the CT scanningdevice when the CT image data 220 of the patient was taken by the CTscanning device. Treatment planning module 200 may also perform a datafill function to create a seamless 3D reconstruction from the CT imagedata 220. A variety of data manipulation and augmentation techniqueswhich assist in rendering useable 2D and 3D structures that can bepresented to and manipulated by the clinician in accordance withembodiments of the present disclosure are described in greater detailbelow. These data manipulation and augmentation techniques are wellknown to those of ordinary skill in the art and their use eitherindividually or in combination can be undertaken without departing fromthe scope of the present disclosure.

With reference to FIG. 4A, once a 3D reconstruction has been generatedfor the selected CT data 220 or if the 3D reconstruction had beenpreviously generated, user interface module 202 presents the clinicianwith a view 230 for identification and selection of a target in stepS416. The view 230 may include identification data including the sourceof the CT image data 220 the patient ID, and the date of the treatmentplan 222, as shown in the banner at the top of view 230. In view 230,the clinician is presented with a slice 234 of the generated 3Dreconstruction in a main view 236. The slice 234 may be taken from thegenerated 3D reconstruction in any one of the axial, coronal andsagittal directions. The slice 234 may be a reformatted CT image, amaximum-intensity projection (MIP), minimum-intensity projection(mIP/MinIP) or other similar forms of presenting a slice 234 of the 3Dreconstruction. FIG. 4A depicts the slice 234 of the 3D reconstructionviewed from the axial direction.

As shown in FIGS. 4B and 4C, the clinician may freely switch the slice234 shown in the main view 236 between the axial, coronal, and sagittaldirections at any time by activating a change views button 237. Forexample, FIG. 4B depicts main view 236 including an axial slice 234 ofthe 3D reconstruction while FIG. 4C, depicts main view 236 including acoronal slice 234 of the 3D reconstruction at the same location afterthe change views button 237 has been activated. In addition, theclinician may also activate the change views button 237 to switchbetween a reformatted slice and a MIP slice, to present a 3D renderedimage of the patient, or to present the slice 234 in any other imageformat. Change views button 237 may alternatively be presented as abutton bar 239 (FIGS. 6C and 10) separately presenting each of the sliceor view options for easy activation by a clinician. The clinician maymanipulate and relocate the image of the selected slice 234 in the mainview 236 and may zoom in or out on the selected slice 234 to obtain anenlarged or reduced view of a particular portion of the selected slice234. Generally it is useful for the clinician to only show a singleslice and direction at a time, for example, only an axial slice 234 fromthe 3D reconstruction, thus the clinician is provided with a simple andclean interface from which to identify and select a target. The changeviews button 237, however, may also be activated to present amulti-plane view in the main view 236 including each of the axial,coronal, and sagittal slices at the same time should the clinician wishto see slices of all three directions at the same time. The multi-planeview may present a volumetric view 267 including a 3D volume 271 derivedfrom the 3D reconstruction in addition to the axial, coronal, andsagittal slices, as described in more detail below with reference toFIG. 6C.

View 230 also includes a localizer 238 which provides a general overviewof the 3D reconstruction for use by the clinician. As illustrated inFIGS. 4A and 4B, localizer 238 includes a localizer view 240 presentinga generic view of a patient's body, for example, the patient's chest,abdomen, and/or lungs, from the coronal direction. The localizer view240 may, for example, present a reformatted CT image, a fluoroscopy-likeimage, a MIP image, MinIP image, or other similar images that present aclinician with a view of the region of interest in the patient's body.Localizer 238 includes a location element 242, for example, a line orbar, extending across localizer view 240 which provides a clinician witha location of the selected slice 234 presented in main view 236 relativeto the patient's body as presented by the localizer 238.

Location element 242 is selectable by the clinician and moveable orslidable relative to the localizer view 240 to allow the clinician toscroll through the slices 234 of the 3D reconstruction of the patient'sbody presented on the main view 236. For example, the slices 234 may bescrolled through or presented in a sequential order defined by the 3Dreconstruction as illustrated in FIGS. 4A and 4B. The clinician may alsoor alternatively click on or select a portion of the localizer view 240to move the main view 236 to the selected slice of the 3Dreconstruction. The clinician may also or alternatively scroll throughthe slices 234 of the 3D reconstruction of the patient's body presentedin the main view 236 via an input device such as, for example, a mousewheel or other device without interacting directly with main view 236 orlocalizer view 240. When the change views button 237 is activated andanother direction is selected for present on main view 236, for example,the coronal direction, localizer 238 may present a generic view of oneof the other directions, for example, the axial direction or thesagittal direction, as shown, for example, in FIG. 4C. Localizer 238provides the clinician with a general reference for where a particularlesion or other target 232 is located in the patient's body. Localizer238 may also present one or more previously selected targets for theclinician's reference.

As illustrated in FIG. 4B, when identifying a target in step S416, theclinician may scroll through the slices 234 in the main view 236 in themanner described above until the clinician identifies a slice 234containing an area of interest. The clinician may also or alternativelydetermine potential areas of interest by looking at the localizer view240 and may move the location element 242 to the potential area ofinterest to present the slice 234 containing the potential area ofinterest on the main view 236. For example, as shown in FIGS. 4B and 4C,a the clinician may identify a dark spot on the liver as the potentialarea of interest which may indicate a potential target 232, for example,a tumor, lesion, or the like.

Referring again to FIG. 4C, once a target 232 has been identified in theslice 234 shown in the main view 236, the clinician positions a targetselection element 243 over the target 232 to select the target 232 fortreatment planning. For example, the clinician may click on the target232 using a user input device such as a mouse, keyboard, or othersimilar device to position the target selection element 243 over thetarget 232. The clinician may also or alternatively drag, slide, ormanipulate the slice 234 presented on the main view 236 using the userinput device until a stationary target selection element 243, forexample, a target selection element 243 permanently centered in the mainview 236, is positioned over the target 232. If display 102 istouch-sensitive, the clinician may also or alternatively touch thetarget 232 on display 102 to position the target selection element 243over the target 232. Examples of target selection elements 243 include acrosshair, a mouse pointer, a hand selection tool, or other similarselection elements. In the multi-plane view a volumetric view 267including a 3D volume 271 derived from the 3D reconstruction may bepresented, as described in more detail below with reference to FIG. 6C.Once the target selection element 243 has been positioned over thetarget 232, the clinician may activate an add a target button 245 toselect the target 232 for treatment planning.

Once a target 232 has been selected for treatment planning by theclinician, user interface module 202 presents a target details view 244to the clinician to allow the clinician to set the target dimensions anddetails in step S418, as shown in FIG. 5A. Target details view 244 mayoverlay view 230 or may replace view 230. Target details view 244provides the clinician with the selected target 232 as shown in an axialslice 246 of the 3D reconstruction, a coronal slice 248 of the 3Dreconstruction, a sagittal slice 250 of the 3D reconstruction, and atarget details pane 251. The axial, coronal, and sagittal slices 246,248, and 250 may be enlarged or zoomed in on the target 232 to providethe clinician with improved visibility of the target 232 and thesurrounding area of interest. Target details view 244 may also present avolumetric view 267 including a 3D volume 271 derived from the 3Dreconstruction, for example, as described in more detail below withreference to FIG. 6C. The volumetric view 267 may replace the targetdetails pane 251. The clinician may also change views by activating achange views button (not shown) of target details view 244 in a similarmanner to activating change views button 237 of view 230 as describedabove.

When setting the target dimensions and details in step S418, theclinician may adjust the width, height, and depth dimensions for thetarget 232, name the target 232, and add additional comments relating tothe target 232 in the target details view 251. In addition, a targetmarker 252, e.g., a crosshair or other similar element, is positionedover the target 232 in each of slices 246, 248, 250 and is manipulatableor movable by the clinician to center the target marker 252 over thetarget 232 in each slice 246, 248, 250. Target marker 252 also includesan adjustable boundary ring 254 that is manipulatable by the clinicianto resize the dimensions of the target 232. For example, as shown in thedifference between FIGS. 5A and 5B, the clinician may resize theboundary ring 254 on each of the axial slice 246, coronal slice 248, andsagittal slice 250 to accurately define or approximate the dimensions ofthe target 232. Boundary ring 254 may be circular, oval, or othergeometric shapes and the shape of the boundary ring 254 may be adjustedto substantially match or closely approximate the general dimensions ofthe target 232, as shown in FIG. 5B. In an embodiment, boundary ring 254may be adjusted in a non-geometric manner by the clinician, for example,a free-form manipulation of boundary ring 254, to conform tonon-geometric dimensions of the target 232. It is important to note thatbecause the target 232 is a three dimensional object such as, forexample, a lesion, tumor, or the like, and each of the axial, coronal,and sagittal slices 246, 248, 250 is taken from a different direction,manipulation and adjustment of the boundary ring 254 in one of theslices 246, 248, 250 by the clinician may result in a change oradjustment of the boundary ring 254 in one or both of the remainingslices 246, 248, 250. In this manner the clinician may accurately setthe target dimensions and the location of the target 232 in all threeviews, effectively mapping the target to specific coordinates anddimensions in a 3D coordinate space. The clinician may also be presentedwith the option to set a surgical margin about the target 232 based onthe target marker 252 when the clinician is planning a lung resectiontreatment procedure. For example, the surgical margin may have a defaultsetting of about 2.5 times the diameter of the largest axis of thetarget marker 252 and may be adjustable by the clinician to increase ordecrease the size of the surgical margin. Once the dimensions andlocation of target 232 have been set by the clinician, the clinician mayactivate the save target button 256 to save the target dimensions anddetails and proceeds to setting the treatment zone in step S420.

During setting of the treatment zone, user interface module 202 presentsa treatment zone view 260 to the clinician, as shown in FIG. 6A. View260 may overlay view 230 and replace view 244 or view 260 may replaceboth view 230 and view 244. Treatment zone view 260 provides theclinician with the selected target 232 as shown in an axial slice 262,coronal slice 264, and sagittal slice 266, and also provides a treatmentzone details pane 268. The axial, coronal, and sagittal slices 262, 264,and 266 may be enlarged or zoomed in on the target 232 to provide theclinician with improved visibility of the target 232 and the surroundingarea of interest. The clinician may also change views by activating achange views button (not shown) of target details view 244 in a similarmanner to activating change views button 237 of view 230, as describedabove.

As shown in FIG. 6C, the treatment zone view 260 may also present avolumetric view 267 including a 3D volume 271 derived from the 3Dreconstruction. The 3D volume 271 may be rendered through surfacerendering, volume rendering, or the like and presents the clinician witha visual understanding of the target location and surrounding anatomicalstructures. For example, 3D volume 271 may be centered on one of thetarget 232, target marker 252, treatment zone marker 270, a distalportion of the representation of needle 283 or instrument 315 (FIG. 10),or any other feature that may require further visual inspection by aclinician. The 3D volume 271 may be a cubic shape, rectangular shape,pyramid shape, spherical shape or may have any other shape as requiredor desired by the clinician. As an example, the size of 3D volume 271 ispreferably sufficiently large to encompass the selected target 232 andthe treatment zone marker 270. For example, the size of 3D volume 271may be from about 1 cm×1 cm×1 cm to about 10 cm×10 cm×10 cm and in anembodiment may be 4 cm×4 cm×4 cm. It is contemplated that the size of 3Dvolume 271 may be smaller than 1 cm×1 cm×1 cm or larger than 10 cm×10cm×10 cm in any direction as needed. The presented 3D volume 271 mayinclude, for example, airways, blood vessels, tissue boundaries, and/orany other relevant anatomical features for the clinicians review. The 3Dvolume 271 may also be rotatable by the clinician by clicking anddragging on the 3D volume 271 or utilizing other user inputs and may beenlarged or reduced in size through the use of tool box 332, asdescribed below.

In the treatment zone details pane 268, the clinician may review andadjust the details and settings of the treatment zone. For example, theclinician may select, input, or adjust needle type (FIG. 6C), powerlevel, duration (time), diameter, minimum margin, and/or maximum marginparameters for the treatment zone. The clinician may also oralternatively be presented with selectable preset power level settings269 (FIGS. 6C and 10) including, for example, 45 W, 50 W, 75 W, and 100W power levels settings. Other preset power level settings 269 are alsocontemplated. The preset power level settings 269 may also correspond toa particular needle type available for treatment in a surgical ablationprocedure. As shown in FIG. 6C, the clinician may also or alternativelybe presented with a selectable needle setting 273 that allows theclinician to select between different types of needles, different needlelengths, or various other needle related settings.

Still referring to FIG. 6A, a treatment zone marker 270, e.g., acrosshair or other similar element, is positioned over the target 232 ineach of slices 262, 264, 266 and is movable by the clinician adjust thelocation of the treatment zone relative to the target 232. Treatmentzone marker 270 also includes an adjustable boundary ring 272 in eachslice 262, 264, 266 that is adjustable by the clinician to resize thetreatment zone relative to the target 232. For example, the clinicianmay resize the boundary ring 272 on each of the axial slice 262, coronalslice 264 and sagittal slice 266 by adjusting at least one dimension ofthe boundary ring 272 to accurately define the treatment zone relativeto the target 232. Boundary ring 272 may be, for example, a circle, ovalor other similar geometric shapes and the shape of the boundary ring 272may be adjusted to define a treatment zone that is preferably equal toor larger than the dimensions of the target 232. Alternatively, theclinician may adjust the boundary ring 272 to define a treatment zonethat is smaller than the dimensions of the target 232. As shown in FIG.6C, a 3D representation of the treatment zone marker 270 in may bepresented in the volumetric view 267 to provide the clinician with anindication of the treatment zone in three dimensions. For example, thetreatment zone marker 270 may be presented as a wireframe 275 in thevolumetric view 267. Alternatively, the treatment zone 270 may bepresented in the volumetric view 267 using surface rendering, volumerendering, or other similar techniques. Adjustment of the orientationand/or position of the treatment zone marker 270 in any of the axialslice 262, coronal slice 264, or sagittal slice 266, may alsoautomatically adjust the orientation and/or position of the 3Drepresentation of the treatment zone marker 270 presented in thevolumetric view 267.

During a typical surgical treatment planning procedure, the treatmentzone is sized by default to be slightly larger than the target 232 sothat the clinician can ensure that the target 232 is completely treated.For example, the treatment zone may be set by default to a 5 mm marginfor a target 232 in the lungs and may be set to a 1 cm margin for atarget 232 in the liver. In one embodiment, because the target 232 is athree dimensional object such as, for example, a lesion, tumor, or thelike, and each of the axial, coronal, and sagittal slices 262, 264, 266is taken from a different direction, manipulation and adjustment of adimension of the boundary ring 272 on one of the slices 262, 264, 266 bythe clinician may result in a change or adjustment of a dimension of theboundary ring 272 in one or both of the remaining views 262, 264, 266.

When the treatment zone marker 270 is adjusted by the clinician, thetreatment parameters, e.g., power, time, and diameter, may also beautomatically adjusted. For example, as illustrated in the differencebetween FIGS. 6A and 6B, as the diameter of boundary ring 272 is reducedfrom 21 to 17, the required power is reduced from 49 to 41, and the timeremains the same at 4. When a specific power level setting 269 (FIGS. 6Cand 10) is preset or selected by a clinician, e.g., 50 W, 75 W, or 100W, the user interface module 202 may present an indication or alert tothe clinician when the clinician adjusts the diameter of the boundaryring 272 to a diameter that is larger than a predetermined maximumthreshold or smaller than a predetermined minimum threshold. Forexample, each power level setting may include predetermined maximum andminimum diameter thresholds for the boundary ring 272. Alternatively,clinician may only be able to adjust the boundary ring 272 between thepredetermined minimum and maximum thresholds and may be inhibited fromadjusting the boundary ring beyond the predetermined minimum and maximumthresholds. Selection of a treatment needle with the selectable needlesetting 273 (FIG. 6C) may also set the predetermined minimum and maximumthresholds based on the properties of the selected treatment needle.

The treatment zone marker 270 may also be adjusted or shaped tocorrespond to the treatment zone characteristics of a particulartreatment probe or needle, for example, an oval shaped treatment zone ora circular shaped treatment zone. Alternatively, the choice of anappropriate treatment probe for the treatment procedure may bedetermined based on the size, shape, or other parameters of thetreatment zone set by the clinician using the treatment zone marker 270or the treatment zone details view 268. In this manner the clinician mayaccurately set the treatment zone dimensions relative to the target 232in all three of the axial, coronal, and sagittal slices, effectivelymapping the treatment zone to specific coordinates and dimensions in a3-D coordinate space. Once the dimensions and location of the treatmentzone have been set by the clinician the clinician may activate the savetreatment zone button 274 and proceed to setting an entry route to thetreatment zone in step S422.

In one embodiment, once the target dimensions and the treatment zonehave been set, the clinician may be presented with the option to selectbetween a number of different treatment procedures for accessing thetarget 232. For example, the clinician may be presented with a list ofavailable treatment procedures from which to select an appropriate ordesired treatment procedure. Alternatively, the clinician may bepresented with the opportunity to select the type of procedure prior toany of the previous steps of the treatment planning method withoutdeparting from the scope of the present disclosure. For example, theclinician may select the type of treatment procedure before or afterselecting the patient in step S402, after selecting CT data 202 in stepS406, after selecting an existing treatment plan or creating a newtreatment plan, after identifying and selecting a target in step S416,after setting the target dimensions and details in step S418, or aftersetting treatment zone dimensions and details in step S420. As anexample, depending on when the type of treatment procedure is selectedin the process, various features and/or settings of the procedureplanning software may be adjusted to match the selected procedure typefor each subsequent step.

The available treatment procedures may be based on the type of target232, the location of target 232, the size of target 232, the size of thetreatment zone, or any other factor or variable which may provide aclinician with an indication of a preferred treatment procedure.Examples of treatment procedures which may be selected or available tothe clinician include open chest thoracic surgery, video assistedthoracic surgery (VATS), endoscopic surgery, cardiac ablation,cryoablation, focused ultrasound ablation, laser ablation,radiofrequency ablation, biopsy procedures, bronchoscopy, lung resectionprocedures, or any other type of procedure for treating a target 232.For example, the clinician may be presented with the option to select anintraluminal procedure and plan a pathway to the target as disclosed inco-pending application Ser. No. 13/838,805 entitled “Pathway PlanningSystem and Method” the entirety of which is incorporated herein byreference.

Once the clinician has selected the desired procedure, in the examplediscussed in detail here, a percutaneous liver ablation procedurerequiring access through the thoracic cavity, user interface module 202presents a view 276 to the clinician for setting an entry route to thetarget 232 in step S424, as shown in FIG. 7. View 276 may overlay view230 and replace view 260 or view 276 may replace both view 230 and view260. View 276 provides the clinician with the selected target 232presented in an axial slice 278. Other view CT slices couldalternatively be presented if they provide a clear viewpoint for theclinician in assessing the entry route to the target 232, accordingly,view 276 may alternatively present the selected target 232 in a coronalslice or a sagittal slice. The clinician may also change views byactivating a change views button (not shown) of view 276 in a similarmanner to activating change views button 237 of view 230 as describedabove. Alternatively, the clinician may set the entry route in treatmentzone view 260 in the manner described below for view 276 without userinterface 202 presenting a new view 276.

View 276 includes a target marker 280 indicating a position of thetarget 232 and an entry route marker 282 extending from the targetmarker 280. The entry route marker 282 includes a first end 284 locatedat a center of the target marker 280, an entry route line 286 extendingfrom the first end 284, and a second end 288. First end 284 is anchoredto the target 232 and may be centered with respect to the target 232.Second end 288 is moved by the clinician to adjust the entry route line286. For example, as shown in FIG. 7, the second end 288 may be moved bythe clinician in a direction “A” to a location where second end 288′ isoutside the body such that the entry route line 286′ of the moved entryroute marker 282′ does not contact ribs or other anatomical featureswhich are undesirable for an entry route. In an embodiment, entry routeline 286 is a linear line or trajectory illustrating a route or pathwayfor accessing the target 232 with a treatment instrument. Alternatively,entry route line 286 may be curved if the selected procedure includesthe use of a flexible catheter or probe through an access portal. Oncethe position of the entry route marker 282′ has been set, the clinicianmay save the entry route by activating the save entry route button 290.In an embodiment, as shown in FIG. 6C, the entry route line may bedepicted as a representation of a probe or needle 283 inserted into thetarget 232. The needle 283 may be shown in any of the axial slice 262,coronal slice 264, and sagittal slice 266. The clinician manipulates theneedle 283 in a similar manner as described above for entry route marker282 to set the entry route to the target 232. In addition, a depthmarker 285 positioned on the needle 283 is slidable by a clinicianrelative to the needle 283 to set a depth measurement of the needle 283relative to a displayed tissue wall 287. The needle 283 may also berepresented in the volumetric view 267 as extending into the 3D volume271 to provide the clinician with an indication of the needle positionrelative to anatomical structures within the 3D volume 271 near thetarget 232. Manipulation or adjustment of the orientation and/orposition of the needle 283 or treatment zone marker 270 in any of theaxial slice 262, coronal slice 264, or sagittal slice 266, may alsomanipulate or adjust the orientation and/or position of 3Drepresentation of the needle 283 or 3D representation of the treatmentzone marker 270 presented in the volumetric view 267.

In other types of selected procedures, for example a VATS procedure, anadditional route line 286 may be displayed to identify the location andplacement of the laparoscopic imaging components. Similarly, where aSingle Incision Laparoscopic Surgery (SILS) port is to be employed, theplacement of the SILS port may be represented and manipulated by theclinician to improve its placement on the patient. In one embodimentwhere two or more surgical instruments are to be deployed the system mayprovide the clinician the option to add additional instruments asnecessary for the contemplated surgery.

After the entry route has been set in step S424 or if the clinicianselects an existing treatment plan in step S410, user interface module202 presents the clinician with a view 292 for reviewing the treatmentplan in step S426. As shown in FIG. 8, for example, view 292 includesmain view 294, an axial slice 296, a coronal slice 298, and a detailspane 300. Main view 294 includes a 3D model 302 of the patient's torsoand abdomen generated by volume rendering, surface rendering, or acombination of volume rendering and surface rendering. Various renderingtechniques that may be used to generate 3D model 302 will be describedin more detail below. Alternatively, the clinician may review thetreatment plan in treatment zone view 260 in the manner described belowfor view 294 without user interface 202 presenting a new view 294.

The 3D model 302 provides the clinician with a representation of thepatient's anatomy and, in an exemplary embodiment, a representation ofthe patient's chest and thoracic cavity, as shown in FIG. 8. The 3Dmodel 302 presents the clinician with multiple layers of the patient'sanatomy including, for example, representations of the patient's skin,muscle, blood vessels, bones, airways, lungs, other internal organs, orother features of the patient's anatomy. For example, as shown in FIG.8, main view 294 presents a 3D model 302 of the patient's thoraciccavity with the outer layers peeled back, removed, or adjusted topresent a layer including the patient's ribs 304 and layers includingother anatomical features 306 of the patient's internal anatomy to theclinician. The layers 304, 306 may be presented at different levels ofopacity or transparency to allow the clinician to review the interior ofthe patient's torso relative to the treatment zone. The 3D model 302 maybe rotated by activating a user input to allow the clinician to view thetreatment plan from various angles and directions. The clinician mayalso activate a user input to peel back, remove, or adjust the opacityand translucence of each layer of the 3D model to provide the clinicianwith a visual representation of the planned entry route to the treatmentzone relative to surrounding critical structures within the patient'sbody. For example, the clinician may activate the change views button313 or a change view button bar 317 (FIG. 10), and select specificlayers to be presented in model 302 or to adjust the opacity ortranslucence of each individual layer. For example, as shown in FIG. 10,a representation of a patient's lung 319 is presented upon selection ofa lung layer from the change view button bar 317.

Still referring to FIG. 8, 3D model 302 includes a treatment zone marker308 and an entry route marker 310. Treatment zone marker 308 isrepresented as a three-dimensional volume within the 3D model 302 andmay be presented in a visually distinct or contrasting color as comparedto the rest of the 3D model 302. As an example, the treatment zonemarker 308 may be presented in a bright green color. The treatment zonemarker 308 is sized to match the treatment zone set during step S420.Entry route marker 310 extends from treatment zone marker 308 out of thebody to an end point 312 as set during step S424.

For example, as shown in main view 294 of FIG. 9, the patient's chest ispresented with 3D model 302 including a representation of the patient'sskin 307 overlayed over the patient's rib cage 304 (FIG. 8) and otheranatomical features 306 (FIG. 8) such that the end point 312 and theentry route marker 310 are shown exiting the representation of thepatient's body. The end point 312 and the entry route marker 310 mayalso be presented as a representation of a surgical instrument 315, forexample, an ablation needle, as shown in FIG. 10. By activating thechange views button 313, all or a portion of the patient's skin 307 maybe made at least partially transparent to present a clinician with a 3Dmodel showing a relative position of the target ablation marker 308(FIG. 8) and the end point 312 to the patient's skin 307. Adjusting thetransparency of the patient's skin 307 allows the clinician to determineboth where the entry route marker 310 enters the patient's skin and alsothe relative location of the entry route marker 310 to other anatomicalfeatures and critical structures once through the patient's skin. Theclinician may also activate the change views button 313, activate achange view button bar 317 (FIG. 10), or the activate the 3D modeldirectly to partially peel back, remove, or adjust each layer in alocalized area 309 to reveal muscle 311, bone, lung 319 (FIG. 10), orother similar structures beneath the skin 307, as shown, for example, inFIG. 11. During lung or liver resection surgery planning, the lung 319(FIG. 10) or liver may also include an indication or indicator of thetreatment zone which presents a clinician with a visual representationof the portion of the lung 319 that is to be resected in the 3D model.The view 294 may also compute and provide an indication of the totalvolume of the target organ (lung, liver, etc.) and a quantification ofthe extent of the resection as compared to the total volume. The changeviews button 313 may also be activated to change the view presented inmain view 294 between each of the views described above with respect toactivating change views button 237 of view 230.

As shown in FIG. 8, details view 300 includes details about the target314, treatment zone 316, and entry route 318. Target details 314 mayinclude, for example, the width, height, depth, volume, and/or otherparameters of the target as set during step S418. Treatment zone details316 may include, for example, the diameter of the treatment zone, volumeof the treatment zone, power level, duration, and other parametersrelated to the treatment zone set in step S420. Details relating to aselected instrument may also be included. Entry route details 318 mayinclude, for example, the length from the end point 312 to the targettreatment marker 308 along the entry route marker 310, and an angle ofthe entry route marker 310 relative to a fixed coordinate plane as setin S422. As shown in FIG. 6C, for example, the depth marker 285 may beset to determine the length from the tissue boundary 287 to the tip ofthe selected probe or needle 283.

During review of the treatment plan in view 292, the clinician may addadditional routes in step S428 and may add additional targets in stepS430 by selecting the add target tab 320 and returning to steps S424 andS416, respectively, or may review other treatment procedures which havebeen previously created by activating a respective target tab 322. In anembodiment, for example, as shown in FIG. 8, when a single target tab322 is selected by the clinician, a target treatment marker 308 ispresented in the 3D model 302 as described above. In an additional oralternative embodiment, the clinician may select or activate a commontarget tab or multiple target tabs 322 at the same time such that atarget ablation marker 308 for each target tab 322 may be presented inthe same 3D model 302 at the same time. This allows the clinician tocompare the locations, sizes, and entry routes for each target in thesame 3D model at the same time.

During review of the treatment plan in view 292, the clinician mayactivate an edit target details button 324 to return to view 244 andstep S418 for modification of the target details. In view 292, theclinician may also select a delete target option 326 to delete thetarget and return to view 230 and step S416 to choose a new target.

If the clinician is satisfied with the treatment plan, the clinician mayexport the plan in step S432 for use during a surgical procedure byactivating the export button 328. The plan may be exported to any formof non-transitory computer readable medium, memory or storage device asdescribed above for memory 104 including, for example, a memory orstorage on the device 100, a removable storage device, exported bytransmission across a wired or wireless connection to a remote or servermemory, etc.

The user interface module 202 may include a navigation bar 330, as shownin FIG. 3A which is activatable by the clinician to switch betweenvarious portions of user interface module 202. For example, asillustrated in FIG. 3A, the clinician may activate navigation bar 330 toswitch between loading images, planning, and review. The navigation bar330 may also include buttons which are activatable by the clinician toreturn the clinician to any previous steps or views of user interfacemodule 202.

Each view of the user interface module 202 may include a toolbox 332 forcontrolling various parameters of the views and slices described above,as illustrated, for example, in FIG. 12. For example, toolbox 332 mayinclude a zoom control 334 and a visual control 336. The clinician mayactivate the zoom control 334 to increase or decrease the zoom level ofthe particular view, slice, or image, in which the zoom control 334resides. The clinician may also or alternatively activate the zoomcontrol 334 to uniformly increase or decrease the zoom level of all ofthe views, slices, or images in a particular view at the same time. Thezoom control 334 setting may also be carried over from view to view asthe clinician progresses through the treatment planning steps describedabove.

Still referring to FIG. 12, visual control 336 includes a window slider338 and a level slider 340. The clinician may activate the window slider338 to control a contrast of a slice or image presented the particularwindow in which the visual control 336 resides while the level slider340 may be activated by the clinician to control a brightness of a sliceor image presented in the particular view where the visual control 336resides. The clinician may also input a contrast or brightness value asdesired. Alternatively or additionally, the clinician may activatevisual control 336 to uniformly adjust the brightness and contrast ofthe slices or images in all of the slices or images in a particular viewat the same time. The visual control 336 setting may also be carriedover from view to view as the clinician progresses through the treatmentplanning steps described above. The visual control 336 settings may alsobe automatically configured depending on the type of treatment procedurebeing planned. For example, the visual control 336 settings may be setto preset values which provide a clinician with enhanced viewing of thepatient's abdomen, airways, liver, lungs, pulmonary system, lunglesions, lung airways, or other similar patient features to allow theclinician to better identify potential targets. For example, each presetvalue may include an indicator corresponding to the particular part ofthe patient's anatomy to be examined.

After a treatment procedure has been completed, the clinician may wishto review the difference between the patient's pre-treatment CT imagedata and post-treatment CT image data. This may be beneficial whererepeated treatments are necessary, for example where treatments must bemade successively to avoid damaging particular structures such as bloodvessels and the like. In an embodiment, treatment planning module 200imports post-treatment CT image data in the manner described above forCT image data 220 and user interface module 202 opens a view 342presenting a pre-treatment slice 344 and a post-treatment slice 346 forthe clinician's review, as shown, for example, in FIG. 13. Pre-treatmentslice 344 is an axial, coronal, or sagittal slice of a 3D reconstructiongenerated from the pre-treatment CT image data 220 while slice 346 is anaxial, coronal, or sagittal slice of a 3D reconstruction generated fromthe newly imported post-treatment CT image data taken after thetreatment procedure. Slices 344 and 346 are positioned in a side-by-sidecomparison so that a clinician may compare the pre-treatment plan andthe post-treatment results to determine if the target has beeneffectively treated. Each of slices 344 and 346 includes a localizer 238and tool box 332 as described above. Slices 344 and 346 may beindependently manipulated by the clinician in the manner described abovefor slice 234 or alternatively may be linked together such that anymanipulation performed on slice 344 by the clinician will be duplicatedon slice 346 and vice versa. Slice 344 may also include a representationor indication of the location of the target to allow the clinician toeasily find the target for comparison to slice 346. The clinician mayalso change the type of view presented in view 342 for each of slices344 and 346 by activating a change views button 348 in a similar mannerto activating change views button 237 (FIG. 4A) of view 230 as describedabove. For example, the clinician may activate the change views button348 to change views between the axial, coronal, sagittal, MIP, 3D, orother similar views.

During any of the above described steps, the treatment planning module200 may employ a variety of rendering and processing algorithms andtechniques to isolate, identify, and/or render the CT image data 220 orthe generated 3D reconstruction for presentation to the clinician.Segmentation is a type of processing algorithm that is typically appliedto medical images in an attempt to define the boundaries of varioustypes of tissue by comparing the values of each data element of the CTimage data or the generated 3D reconstruction to a series of thresholdsor other similar criteria. The segmentation algorithm groups togethersimilar types of tissue, for example, lungs, airways, lung lobes,nodules, vessels, liver, ribs, heart, or other critical structures,based on the outcome of the comparison. Each group may then beseparately processed for rendering and presentation to the clinician bythe treatment planning module 200. For example, because the intensity ofeach pixel in a CT image is equivalent to an actual density of thetissue material that was scanned, segmentation may be used to separatetissue material having different densities by analyzing the intensityvalues in the CT image.

One benefit of segmentation is the ability to present each criticalstructure of the patient's anatomy to the clinician in visual formhaving a different color and/or transparency. This provides theclinician with an easy way of identifying different tissue types withinthe same image. For example, once segmented into groups, the lungs,airways, bones, etc. can each be presented with a different color ordifferent transparency setting that may be adjustable by the clinician.

The treatment planning module 200 may utilize common techniques forsegmentation including, for example, binary masking, determination ofthe optimum threshold that separates tissue and background, adaptiveregion growing, wavefront propagation, automatic or manual determinationof seed points in the trachea, liver, or other critical structures, afill holes algorithm for filling in holes in the binary mask by floodfilling the background and inverting the result, a rolling ballalgorithm to close the airways, blood vessels, and indentationscorresponding to peripheral nodules, and a morphological closingoperation.

The treatment planning module 200 may also segment tumors, eitherautomatically or once identified by the clinician, from the surroundtissue and present the clinician with the option to designate a seedpoint in an identified tumor. Using the seed point, treatment planningmodule 200 creates a region of interest around the seed point andsearches for a threshold that results an object corresponding to thetumor. In this manner, an approximation of the boundaries of the tumoris mathematically determined based on the differences in the images on avoxel by voxel basis. This approximation can be implemented in thetarget identification steps described above. The segmented tumor mayalso be presented to the clinician as a 2D or 3D model which allows theclinician to determine the size and dimensions of the segmented tumorand the location of blood vessels or other similar features of interestin the segmented tumor.

As described above, treatment planning module 200 is configured topresent a 3D model or representation of the patient's anatomy to theclinician. Treatment planning module 200 may utilize a variety ofwell-known 3D rendering processes or techniques to generate all or partthe 3D model. For example, treatment planning module 200 may applysurface rendering to the 3D reconstruction or to a segmented portion ofthe 3D reconstruction to generate a 3D model or image for presentationto a clinician. During surface rendering, the treatment planning module200 receives the 3D reconstruction and applies binary masks and variousfilters to the 3D reconstruction to generate a surface mesh. Examples ofwell-known filters used in surface rendering include dilation filters,masking filters, gaussian filters, and contour filters. Treatmentplanning module 200 may, for example, generate different kinds of 3Dsurface rendered images of a lung or another part of the patient'sanatomy by using different combinations of filters and algorithms. Inone example, the treatment planning module may apply a marching cubesalgorithm to a segmentation of the lung to generate the 3D surfacerendered image. In another example, the treatment planning module 200may apply an image smoothing filter to the segmentation of the lungprior to applying the marching cubes algorithm to generate a 3D surfacerendered image having a smoother surface. In yet another example, thetreatment planning module 200 may use customized parameters on thesegmentation of the lung or on the generated 3D surface rendered imagesto generate a surface rendered image having additional shine andsmoothness. The level of shine and smoothness in the presented 3Dsurface rendered image may assist the clinician in identifying featureson the outside surface of a lung or other structure that may beindicative of a potential target or area of interest.

The treatment planning module 200 is also configured to apply volumerendering to the 3D reconstruction or to a segmented portion of the 3Dreconstruction to generate a 3D image for presentation to a clinician asis well known in the art. Volume rendered 3D images may show roughtextures on the rendered surface which may assist a clinician inlocating and identifying a target or area of interest on a surface ofthe 3D image. For example, the volume rendered 3D image may assist theclinician in identifying a diseased portion or an adhesion and may alsobe a useful tool for locating the peripheral nodules and potentialtargets of interest on the surface of a patient anatomy during thetreatment planning procedure.

Treatment planning module 200 may also be configured to utilize bothsurface rendering and volume rendering at the same time to generate a 3Dimage for presentation to the clinician. For example, a skin surface maybe surface rendered over a volume rendered 3D model. The transparency ofskin surface may be adjusted at an area of interest to allow the volumerendered 3D model to be visible to the clinician. The clinician mayutilize the 3D image during surgical treatment planning to determine,for example, a relative location of the target of interest to thepatient's external anatomy, the location of the patient's ribs or otherstructures relative to the patient's external anatomy, potentiallocations for an access route to the target, potential locations forplacement of an access portal, or other similar uses.

Treatment planning module 200 may also configured to simulate differentstates of the patient's anatomy in the 3D images. For example, thetreatment planning module 200 may simulate the patient's left lung andright lung in both inflated and deflated states using a lung deflationalgorithm. The lung deflation algorithm deforms one of the left andright lungs by using a thin-plate splines algorithm and leaves thetrachea and the other lung unmodified. Anchor points may be providedwhere the deformed lung and bronchi connect to the trachea to providefor seamless deformation. The treatment planning module 200 may alsosimulate deflation of both the left lung and right lung simultaneously.

While the foregoing has been described and set forth with respect todetermining medical treatment procedure including planning a route to atarget within a patient, the same methodologies and systems may beemployed to in a planning procedure to identify a target, a route to thetarget and to conduct a review of the proposed approach for treatment orservicing in other contexts, including without limitation analysis ofpiping systems, electronic systems, and other industrial applicationswhere access to a target is limited and internal analyses of the systemin question are required to ascertain the most desirable pathway toreach the target.

Although embodiments have been described in detail with reference to theaccompanying drawings for the purpose of illustration and description,it is to be understood that the inventive processes and apparatus arenot to be construed as limited thereby. It will be apparent to those ofordinary skill in the art that various modifications to the foregoingembodiments may be made without departing from the scope of thedisclosure.

What is claimed is:
 1. A system for planning a treatment procedure, thesystem comprising: a computing device including a memory and at leastone processor; and a program stored in the memory that, when executed bythe processor, presents a user interface that guides a user through theplanning of a treatment procedure, the user interface including: atarget selection view presenting a slice of a 3D reconstructiongenerated from CT image data of a patient, the target selection viewconfigured to select at least one target anatomical feature from thepresented slice in response to a received user input; a treatment zonesetting view presenting at least one slice of the 3D reconstructionincluding the target anatomical feature, the treatment zone setting viewfurther presenting an adjustable treatment zone marker defining alocation and a size of a treatment zone and at least one treatmentparameter value for achieving the treatment zone, the treatment zonesetting view configured to enable adjustment of a size of the adjustabletreatment zone marker in response to a received user input to theadjustable treatment zone marker, wherein adjustment of the size of thetreatment zone defined by the adjustable treatment zone markerdynamically causes a change to the at least one treatment parametervalue, wherein adjustment of the size of the treatment zone defined bythe adjustable treatment zone marker is limited by, and inhibited frombeing adjusted beyond, a predetermined maximum threshold sizecorresponding to a selected treatment needle that remains unchanged byadjustment of the size of the adjustable treatment zone marker and apredetermined minimum threshold size corresponding to the selectedtreatment needle; an access route setting view configured to set anaccess route to the treatment zone in response to a received user input;and a review view configured to present a three-dimensional model of thetreatment zone and the access route.
 2. The system according to claim 1,wherein one or more of the treatment zone setting view, access routesetting view, and review view are presented separately.
 3. The systemaccording to claim 1, wherein at least one dimension of the adjustabletreatment zone marker is adjustable in response to a received user inputto adjust the size of the treatment zone.
 4. The system according toclaim 3, wherein the treatment zone setting view presents each of anaxial slice of the 3D reconstruction, a coronal slice of the 3Dreconstruction and a sagittal slice of the 3D reconstruction, andwherein the adjustment of the at least one dimension of the adjustabletreatment zone marker in response to the received user input in one ofthe axial, coronal, and sagittal slices adjusts at least one dimensionof the adjustable treatment zone marker in at least one other of theaxial, coronal, and sagittal slices.
 5. The system according to claim 1,wherein the at least one treatment parameter value is adjustable inresponse to a received user input to adjust the at least one treatmentparameter value, wherein the user input to adjust the at least onetreatment parameter value is different from the received user input toadjust the adjustable treatment zone marker.
 6. The system according toclaim 1, wherein the at least one treatment parameter value is selectedfrom the group consisting of a power setting, a duration setting, aninstrument type, and a size of the treatment zone.
 7. The systemaccording to claim 5, wherein adjusting the at least one treatmentparameter value automatically adjusts at least one other treatmentparameter value.
 8. The system according to claim 1, wherein thetreatment zone is presented in the three-dimensional model as athree-dimensional treatment volume.
 9. The system according to claim 1,wherein the treatment zone setting view presents an alert if the size ofthe treatment zone defined by the adjustable treatment zone markerreaches the predetermined maximum threshold size corresponding to theselected treatment needle.
 10. A non-transitory computer-readablestorage medium encoded with a program that, when executed by aprocessor, causes the processor to perform the steps of: importing CTimage data of a patient; generating a 3D reconstruction from the CTimage data; presenting a slice of the 3D reconstruction; selecting atarget anatomical feature from the slice of the 3D reconstruction inresponse to a received user input; setting a treatment zone in responseto a received user input including: presenting at least one slice of the3D reconstruction including the target anatomical feature; andpresenting an adjustable treatment zone marker defining a location and asize of the treatment zone on the presented at least one slice of the 3Dreconstruction; presenting at least one treatment parameter value forachieving the treatment zone; adjusting the size of the treatment zonedefined by the adjustable treatment zone marker in response to areceived user input to the adjustable treatment zone marker, whereinadjustment of the size of the treatment zone defined by the adjustabletreatment zone marker is limited by, and inhibited from being adjustedbeyond, a predetermined maximum threshold size corresponding to aselected treatment needle that remains unchanged by adjustment of thesize of the adjustable treatment zone marker and a predetermined minimumthreshold size corresponding to the selected treatment needle;dynamically changing the at least one treatment parameter value based onthe adjusting the adjustable treatment zone marker; setting an accessroute to the treatment zone in response to a received user input; andpresenting a three-dimensional model including the treatment zone andthe access route.
 11. The non-transitory computer-readable storagemedium according to claim 10, wherein setting the treatment zoneincludes adjusting at least one dimension of the adjustable treatmentzone marker to adjust the size of the treatment zone.
 12. Thenon-transitory computer-readable storage medium according to claim 11,wherein the adjustable treatment zone marker is presented in each of anaxial slice of the 3D reconstruction, a coronal slice of the 3Dreconstruction, and a sagittal slice of the 3D reconstruction, whereinadjustment of the at least one dimension of the adjustable treatmentzone marker in one of the axial, coronal, and sagittal slicesautomatically adjusts at least one dimension of the adjustable treatmentzone marker in at least one other of the axial, coronal, and sagittalslices.
 13. The non-transitory computer-readable storage mediumaccording to claim 10, wherein setting the treatment zone furtherincludes: adjusting the at least one treatment parameter value inresponse to a user input to adjust the at least one treatment parametervalue, wherein the user input to adjust the at least one treatmentparameter value is different from the received user input to adjust theadjustable treatment zone marker.
 14. The non-transitorycomputer-readable storage medium according to claim 10, wherein the atleast one treatment parameter value is selected from the groupconsisting of a power setting, a duration setting, an instrument type,and a size of the treatment zone.
 15. The non-transitorycomputer-readable storage medium according to claim 13, whereinadjusting the at least one treatment parameter value automaticallyadjusts at least one other treatment parameter value of the treatmentzone.
 16. The non-transitory computer-readable storage medium accordingto claim 10, wherein the treatment zone is presented in thethree-dimensional model as a three-dimensional treatment volume.
 17. Thenon-transitory computer-readable storage medium according to claim 10,wherein an alert is generated if the size of the treatment zone definedby the adjustable treatment zone marker reaches the predeterminedmaximum threshold size corresponding to the selected treatment needle.